Inspection on 16/05/07 for Harriet`s

This inspection was carried out on 16th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Harriet`s 27/04/10

Harriet`s 08/05/08

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Harriet`s 119 Main Street Distington Workington Cumbria CA14 5TA Lead Inspector Nancy Saich Unannounced Inspection 16th May 2007 9:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harriet`s Address 119 Main Street Distington Workington Cumbria CA14 5TA 01946 831166 01946 834373 harriets@schealthcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Healthcare (Focus) Limited Mr Christopher R Middleton Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (41) of places Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, maximum number of places: 41 2. Dementia - Code DE, maximum number of places: 41 The maximum number of service users who may be accommodated is 41. Date of last inspection Brief Description of the Service: Harriets is a purpose built home situated in the village of Distington, midway between Workington and Whitehaven. The home has been open for a number of years but has recently been taken over by Southern Cross Healthcare. The Southern Cross group of companies operate a number of care and nursing home throughout Britain. The home is registered to care for older adults or people who need care because they suffer from dementia. Charges range from £363 to £422 per week depending on needs. Further information may be accessed from the home or via the Southern Cross website Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of the home since Southern Cross became the registered providers in March this year. The lead inspector sent out surveys to residents, relatives and visitors some weeks before she visited the home. She also asked the acting manager to send her some information and this was done promptly. She visited the home unannounced and was accompanied by another inspector Margaret Drury and by a regulation manager –Penny Wilkinson. They met with residents, staff and the acting Manager. They visited all areas of the building and read files and documents that backed up what they saw and what was said to them. What the service does well: The home is good at only admitting people they know they can care for and who will fit in with existing residents. Residents get good health care in this home and the staff look after medication properly. The home is good at making relatives and friends feel welcome and encourage people from local groups to come to the home. Residents were happy with the choice, quality and presentation of food. The home is good at listening to any concerns or complaints. They showed that they were aware of how to protect people from harm. Over 70 of the staff team have national Vocational Qualifications in care at level 2 or higher. The acting manager makes sure that she follows company policy and doesn’t employ any new person with a criminal record or who has been dismissed from any other care setting. The home is good at making sure they look after residents’ cash correctly. Systems to make sure health and safety were in place were of a good standard. This included good systems for fire safety and food hygiene. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? The home has made a lot of improvements to the way they write the plans for each individual resident’s care. The inspectors were pleased to see that every resident was being given the chance to look closely at their care every six months. The inspectors judged that staff were becoming much more sensitive to the needs of individual residents. Surveys said that staff attitudes had improved recently. A number of residents said that they had never found the staff to be anything other than: • • ‘Grand lasses…’ Lovely…very nice to me…’. There have been no formal complaints since the last key inspection and residents said they could talk to the acting manager and to representatives of Southern Cross. Residents said there was nothing unpleasant going on and no one had any complaints on the day. The acting manager has made the home cleaner and tidier and improved a number of areas and as residents said ‘got rid of all the clutter’. The management have made sure that ‘bank’ staff cover any staff shortages. There are usually good ratios of staff to residents. The management have improved the content of training and the amount of support they provided to staff. Residents feel they have a staff team who are good at looking after all aspects of their lives The recording systems in the home were much better since the introduction of Southern Cross’ own records management. The fire training was up to date at this inspection and staff aware of the need to attend training. What they could do better: Southern Cross need to provide a new document describing the home – including a new brochure. They also need to give residents new contracts. The staff need to keep working on the written plans for care so that residents get more support and help in all aspects of their lives. The inspectors want to see the staff team continuing to work together to make sure that every person on the team treats people with respect and dignity. The inspectors judged that there had been fewer activities and trips on offer and want the company to take steps to improve on leisure and cultural activities. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 7 They also had some evidence to show that sometimes peoples’ needs came second to the routines of the day. Residents need more real choice and involvement in how they live their lives. There was some evidence to show that the company have started to do some work in the home but the environment remains shabby and in need of redecoration and repair. The residents want timescale and details of how the company is going to improve the home. There are a number of requirements made about this at the end of this report. Southern Cross needs to find the residents and staff a new manager who will continue to help the home to improve.They need to keep working on their quality systems so they find out what residents really want from the service. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The company need to improve their information for residents so that they give them all the information they need before they come into the home. EVIDENCE: The inspectors found that some important documents were not up to date. Southern Cross must make sure they produce a new Statement of Purpose that explains what they provide in this home. They also need to produce a new brochure for residents and give them new contracts where necessary. Together these things will help both prospective residents and professionals to understand their intentions. The inspectors met some new residents and read their files. They found that there were very good assessments done by the home and files had both social work and health care assessments They judged that the home is good at understanding the needs of new people. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who live in this home receive a good standard of personal and health care and this helps them to be as well and happy as possible. EVIDENCE: The inspectors read the written plans of care for a good proportion of residents. They also read the daily notes about health and personal care. They met with residents and observed them being helped and supported by staff. They also noted that all of the returned surveys were generally very positive about the way care was provided. They judged that the written plans of care were much better than they had been. They thought that the Southern Cross format was very good. The inspectors were pleased to see that every ones’ care was going to be reviewed thoroughly every six months. One of the inspectors met with a family and a resident who were helping the staff to update this persons care plan. They all said they were Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 11 • ‘delighted to have the opportunity’. They were aware that senior carers had started to do these plans with residents. Some of the plans were very detailed and residents felt they met their needs. Other plans needed a bit more detail. Things like encouraging independence, including social, emotional and recreational needs or dealing with challenging behaviour need to be planned in more depth. Residents were happy with the health care and support they receive. Several files showed how well the staff had helped people to get over illnesses. People with dementia get specialist help from doctors and nurses. Two of the inspectors checked the medicines held on behalf of residents. These were being managed properly. Residents’ care doesn’t rely on the use of sedative medication. Residents are being supported to take their own medicines where possible. The inspectors watched staff as they went about their daily work. They found them to be friendly, kind and considerate to residents. Here are some of the things residents or relatives said: • • ‘They are wonderful with me…I always receive help when I need it…’ ‘The staff have affection for my relative and treat her with care and respect especially now she has become frailer…’. The inspectors judged that although generally staff were good at supporting privacy and dignity there were one or two instances where some members of the team need to look at their approach. For example one survey said that some staff behaved as if all older people were hard of hearing. The acting manager agreed that some staff did need to work on their approach and explained how she was working on this through staff supervision and development. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With a little more work this home will give residents the opportunities that they want to have a fulfilling life. EVIDENCE: Some residents said they had the lifestyle they wanted. Some people and some surveys questioned whether staffing levels always allowed people to have real choices. However they also said that this was improving. It was nice to see that people used their rooms as they wished or could choose to spend time doing some activities or in the company of other people in the lounge. Staff were being encouraged to spend more one-to-one time with residents. Residents said that recently there had been fewer activities on offer due to staffing problems. There hadn’t been very many entertainments in the home and residents care plans didn’t show enough individual activities on offer. Residents did say they had gone out for trips but everyone wanted the Harriets’ own min-bus back on the road. Together these things mean that the social, leisure and recreational activities didn’t quite meet the standard Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 13 expected. However the staff and residents were hopeful that this was being dealt with. A number of relatives were in the home and they said they were always made welcome. The residents said they had visits from local clergy and their spiritual needs were being well met. There was some evidence in residents’ meetings minutes that people were having more say in the way the home was run and that their opinions were being sought. The inspectors look forward to a time when residents are much more involved in the way things are going. They did think that there had been improvement in consultation and that things were on the right track with more emphasis on residents’ views. Residents’ surveys were very complimentary about the food provided. The residents on the day said they enjoyed their meals. The inspectors joined the residents and were served a very nicely cooked and presented lunch. The cook said that they were planning to change the menus but were waiting for some guidelines from Southern Cross. The cook consulted residents after lunchtime and the inspectors’ thought that was a good way of keeping people happy. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is good at both listening to and protecting residents so that they can feel secure. EVIDENCE: There had been no formal complaints made to the acting manager or to the lead inspector since the last inspection. Residents said that they had no complaints and no concerns about anything unpleasant going on in the home. The surveys and discussions showed that the residents trusted staff and the manager to listen to their concerns and a number of people said that this was a big improvement from the way things were in the past. The manager had been on a training course to help understand how to protect older people from abuse and harm. She had trained staff in turn and the inspectors judged that the staff they spoke to were very knowledgeable about how to protect people and how to report and deal with abuse Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home is much tidier than before the registered provider needs to invest time and money to bring the entire home up to a good standard. EVIDENCE: Harriets has suffered from a lack of investment in renewal and major maintenance projects and this means that all around the home a number of areas are shabby and poorly maintained. The inspectors walked around all areas of the building and felt that there were problems in the following areas: • Corridor and dining room carpets need repair or replacement. • Some windows need repair or replacement. • Bedrooms need new beds and other furniture • Various parts of the home need redecoration Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 16 • • Woodwork (radiator covers, skirting boards, doors) need upgrading or repair. Access to safe outdoor space needs to be improved. The lead inspector and the Regulation manager had asked Southern Cross prior to registration to send them a plan of how and when they would be refurbishing the home. Residents and staff wanted to know the timescales for the promised changes to the environment. The plan had not been received by the day of the visit and the manager did not have a copy. The residents and relatives said that staff had been very busy clearing out what they described as ‘clutter’. The home seemed bigger, brighter and more open from this very good ‘spring clean’. They had also made the dining and sitting areas tidier and now the lounge and conservatory are arranged in small sitting areas that make these rooms more homely and that residents said they enjoyed socialising in. The dining areas are now separate and there is a small room used for activities. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home has a committed staff group who are being supported and guided in improving and refining their skills and knowledge to give residents all the care they need. EVIDENCE: Surveys and discussions with residents showed that there had been some problems with the staffing levels. However that has recently improved and the company could assure the inspectors that there will be ‘bank’ staff available in the future. The inspectors also thought that changes to the rosters had improved the way staff worked. More than 70 of the staff group have a National Vocational Qualification in care at level 2 or above and new people are being registered to complete this award. The team have undertaken a number of training courses with Southern Cross. This company like staff to be experts in specific areas and then to ‘cascade’ that training down to others. Recently two staff have become trainers in manual handling and they have started to train others and check their abilities in moving and handling people. The acting manager has completed training in protecting vulnerable adults and has trained nearly all the staff. Two team Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 18 members have become trainers in dementia awareness and this training is being planned. One of the inspectors checked on how new staff were recruited. She found that the company have very good systems in place. They make sure all checks are in place so that only suitable people are taken onto the team. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36,37,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Until the residents have a person who is the named manager and they are aware of the future plans for the home people will not feel as secure as they should. EVIDENCE: Currently the home does not have a registered manager and the deputy manager has covered this role for some time. Residents and staff were happy with her being in charge. Surveys from relatives and local surgeries also said she was doing a good job in leading the home. She has the right kind of skills and knowledge to be running the home for the time being. She has moved things forward in the absence of a manager and said she was being very well Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 20 supported by the company. However the inspectors judged that residents want stability and look forward to the appointment and registration of a new manager. The inspectors saw lots of things in documents about care, staffing and services that showed the company have a good quality assurance system that staff are comfortable working with. The lead inspector is happy to wait for these quality measurements to be audited by the company once they have operated the home for a little longer but want them to continue to work on this so that the residents’ opinions can be acted upon. Southern Cross had still not provided the acting manager or the inspector with a specific business and financial plan for the home. The company needs to make a clear plan available that will help residents feel comfortable with what is going to happen to their home in the next few years. Residents’ money held on their behalf was small amounts of cash for paying people like hairdressers. These accounts were all in order when the inspectors checked them. They thought that the new system was an improvement and it was clear and easy to understand. The inspectors read supervision notes and these were much improved and staff thought they were getting much more support on a one –to-one basis. The inspectors looked at a wide range of records in the home and they found that these had really improved partly due to the company formats but also because management and administration had worked hard to reorganise the systems. They also checked on health and safety issues in the home. Again these systems were operating much more smoothly than before. Fire safety was in order, as were all the systems in the kitchen. They judged that the management assured safe working practices in all areas of the home. They did however consider that the time was right to redecorate and reorganise the layout of the kitchen. Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 2 3 3 3 2 Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 Requirement Southern Cross must produce an up to date statement of purpose that clearly explains to people what the home provides in terms of care and services. Southern Cross must make sure that leisure and recreational activities and routines of daily living are made much more flexible and readily available. The registered provider must ensure that a suitably qualified and experienced manager is recruited. The process should be in place by the due date. A business and financial plan must be in place that gives details of both long and shortterm proposals for the home. This must include details (including costs and time scales) of how the environment is to be improved. Timescale for action 30/06/07 2 OP12 12 and 16 30/06/07 3 OP31 8 30/06/07 4 OP34 24 30/06/07 Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP2 OP7 Good Practice Recommendations It is recommended that Southern Cross review and update residents contracts. It is recommended that the care plans in the home become more detailed and include more strategies for helping residents to retain independence, deal with behavioural problems or increase their lifestyle choices. It is recommended that staff continue to look at how they deliver care so that people always feel that they are treated with complete dignity and respect. It is recommended that the acting manager and the staff continue to work on helping residents to exercise choice and control over their lives. It is recommended that the refurbishment plan include plans for providing safe and accessible outdoor space for residents. The home should identify bedrooms that need upgrading and make sure they have a plan that will help improve private accommodation for residents. It is recommended that the quality monitoring system is reviewed and outcomes audited so that residents can have a say in the future of the home It is recommended that the registered provider look at the environment and layout of the main kitchen. 3 4 5 6 6 7 OP10 OP14 OP20 OP24 OP33 OP38 Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Harriet`s DS0000069676.V339791.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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